Medical consent and Deafblind patients

Cathy Metcalf

21 November 2001

[Webmaster's note: This was a letter to TERPS-L that I requested the author to give permission to print]

I want to thank each and every one of you who
sent me advice and encouragement for my Deafblind
surgery assignment, both on-list and privately!
What a wonderful help you all were, and I used as
many of your suggestions as I could...smile.

Let me tell you that it turned out quite well, and
it wasn't the "bear" I thought it was gonna be!
So the experience was, in general, a positive
one, but several issues came up that I thought
were worthy of mentioning.

The hospital does not deal with Deafblind very
often, so that is a given. This is a relatively
small/rural community, and the hospital is
actually just now getting up to speed on dealing
with deafness, calling interpreters, etc.

Okay, on the morning of the surgery, I arrived on
time, and was led back into the patient check-in
area (where the patients fill out pre-admit
forms)
where the patient was sitting with a non-signing
Hearing family member. The necessary legal
forms had already been filled out by the family
member while the patient slept in the chair, not
knowing what was going on. I asked if the family
member could sign/communicate with the
patient (no), if the patient knew what forms had
just been filled out on his behalf (no), if the
family member had Power of Attorney (no), and why
they hadn't waited for the
interpreter (Ummmmm????).

Apparently, the hospital wanted to stay on
schedule, and was getting the *routine*
paperwork (power of attorney, living will, and
that kind of stuff) out of the way ahead of time.
I mentioned that those forms may/may not be
legal since the family member who signed his name
to them did not have power of attorney, but it
was their call. I let them know that what
concerned me the most was that the patient did
NOT know what forms had been signed on his
behalf, and that they should have waited for the
interpreter. (Geesh, I was ON TIME and
everything!)

I asked what forms had been signed, then
proceeded to explain to the patient what had been
done on his behalf. He seemed used to others
signing papers for him, and answering for him,
sadly. Technically, I think the hospital probably
should have gotten the patient to re-sign the
forms now that he understood what they were, but
it was not my place to suggest it--not professing
to be a lawyer...

I don't know how the situation could have been
prevented, barring education of the hospital
staff. Even if I had mentioned "wait for the
interpreter" when I called to confirm the day
before, who knows if the message would have even
gotten through???

As the procedure went on, I was on really alert
for hospital staff attempting to "go around" the
patient. They seemed bent on asking the family
member questions about the patient rather than
asking the patient himself. Whenever a question
was asked (EX: What allergies do you have??), I
would wait for the family member to answer, and
no matter what his/her answer was, I asked the
staff to wait just a second, and let me ask the
patient himself. They caught on rather quickly
to the scheme of things, and began asking the
patient directly (OK, they said the usual "Ask
him...", but it was an improvement!.) The patient
was intelligent and could, indeed, answer for
himself. I did my best to act professionally, not
insult well-meaning staff and family members, yet
get the info to the patient and let him decide
and answer for himself. You guys would have been
proud of me, I think, because, by the end, we
even had the Deafblind patient signing the
consent/release forms and other papers
HIMSELF!!!!

As far as the mechanics of interpreting for the
patient in the bed, it wasn't too awfully
difficult. I did ask for the O2 clothespin to be
clipped to the patient's non-dominant hand, as
well as the IV, simply for my ease in reading his
fingerspelling. The greatest problem was not with
IV's, but with the side rails of the bed. At one
point I asked the anesthesiologist to wait just
one sec while I moved to the side w/o rails.
Another source of difficulty was with the
post-surgery, recovery room situation. The
patient had piles of blankets on him to keep him
warm, one of the blankets being an
air-mattress-like thing. So here was the groggy
patient, trying his best to come out of
anesthesia fog, signing with one hand to
me....LOL I did the best I could to understand,
but ended up putting off his comments, waiting
until the patient was warm, a bit more
clear-minded, and willing to bring both hands out
from under the mountain of covers. smile.

What was sorta funny was that the patient went
through the whole procedure, then asked "so when
is surgery??". Evidently he had forgotten
everything that had happened, and we both
had a big laugh as I informed him "surgery
finish"!! He had been so heavily drugged that he
was disoriented ....(kinda like me on a Monday
morning before coffee....smile)

Before the surgery I had worried about how to
interpret to him, what problems might come up in
connection with that. But really, what was the
predominant issue was dealing with the hospital
staff, since they were unfamiliar with the
Deafblind. I don't mean it in a snotty way when
I say that part of our "job" as interpreters is
to bridge the gap and "educate" the Hearing
around us. It made me smile at the innocent
hospital staff responses of "Wow" and
"fascinating", and "He really understands!" as I
interpreted the Dr.'s commands to the patient
(roll over on your left side; scoot up to the top
of the bed; take a deep breath and hold it; etc.)
and the patient understood and complied. I guess
this was their first experience seeing(through an
interpreter) that the man was intelligent,
literate, humorous, and even flirtatious with the
nurses and me (oops, I promised not to tell on
him...LOL)!! The doctor even told the staff not
to let the interpreter out of their
sight....guess he was a little nervous with a
Deafblind patient too. He wanted me to wait 5
hours with the patient so that if the patient had
pain, they would know it...LOL. Of course, I
could not, ethically stay and do virtually
nothing for 5 hours, especially since I had
another appt., so I did some more educating and
reassurance that the patient, as well as the
family member were quite able to let them know of
his possible pain. I asked the nurse to explain
the call button to the patient while I
interpreted, and also explained to the desk not
to verbally answer the call button but to go into
the room to assess the patient's needs.

All in all, it was a very satisfying experience
for me, and I think the patient appreciated
having an interpreter and knowing what was going
on around him. He made good use of me by asking
lots of "who is in the room" and that type of
environmental questions. When it was all over and
I was ready to leave, he thanked me big time for
interpreting.